Infection Control and Hand Hygiene Discussion with Professor Didier Pittet

Emma Barrett, Global Market Manager for Healthcare and Infection Prevention at Diversey had an opportunity to speak to Professor Didier Pittet ahead of the May 5th World Hand Hygiene Day Celebrations and hear what he has to say about the campaign, and the WHO Global Survey.

#1 Diversey: Can you please tell us a little about yourself and your role at one of the World Health Organization Collaborating Centers?

Professor Didier Pittet: My name is Professor Didier Pittet, I've been the Director of Infection Control Program, University of Geneva Hospitals and Faculty of Medicine for many years. I started the program in 1992 and have worked with the World Health Organization (WHO) on many different topics. The essential and key element that brought me to work so closely with WHO and become a WHO Collaborating Centre was the work around infection control and hand hygiene, in particular in the field of patient safety.

To make a long story short, the WHO worked with the University of Geneva Hospital to promote a strategy for hand hygiene in the early 90's and that strategy was endorsed by several hospitals and countries from around the world. In 2004 the WHO approached me to see if I was willing to deliver these hand hygiene promotion campaigns to the rest of the world. They asked if I would host the first "Global Patient Safety Challenge" for the World Health Organization and of course, I said yes. This challenge was the first patient safety challenge and it rapidly became extremely powerful at mobilizing nations from all around the world.

In the first challenge, we asked Ministries of Health to pledge three things:

To recognize the existence of healthcare-associated infections (HAI) in hospitals and in institutions of care all around the world.

To recognize that hand hygiene was the most important element to reduce HAI, and that the multi-modal strategy developed between the WHO Collaboration Center in Geneva and WHO could be successful at promoting hand hygiene. That success could be measured by a reduction of HAI and microbial resistance spread and if countries could endorse the strategies.

We asked countries to share some of their results and activities so that we could share knowledge from the challenges around the world.

All this was launched in 2005, and today in 2019 a total of 142 countries of the United Nation member states have signed the hand care challenge. In the meantime, multiple activities developed include new guidelines for hand hygiene including a multi-tool that links to a multi-modal implementation strategy developed to become a universal strategy promoting hand hygiene all over the world. In the strategy, it's clear that we alert people to not only endorse the strategy but to also the idea of adapting the strategy in order for people to adopt and make the strategy their own. This is where we developed the concept I like to call "Adapt to Adopt".

#2 Diversey: You are introduced as the Hand Hygiene Provocateur, is that a title you appreciate, and how did you earn it?

Professor Didier Pittet: (laughs). It’s not me that chose the title, it was the Ted Talk team, the initial title “Hand Hygiene” was not considered very attractive and so they wanted something exciting to attract people to the talk. That's probably why they choose the title “Hand Hygiene Provocateur”. There were many candidates, but I became the proposed representative person at the United Nations to give the Ted Talk because I was the only person from Geneva, Switzerland.

Now, whether or not I'm a provocateur, I don't know, I do know at the time we proposed this major system change as part of the multi-modal strategy that replaced soap and water hand washing with the use of alcohol-based hand rubbing. It was a revolution! Several papers have been written about a revolution in hand hygiene and definitely a revolution in patient care. Some people felt it was a revolution in healthcare. And yes, it was a revolution, so somewhere between being a provocateur and inducing a revolution in healthcare, I guess there is only one step to make so I can certainly accept the title. I don't like it very much any more because I am not really supposed to be a provocateur. I was certainly an innovator and an innovator of a “Rupture”, or “Disruptive innovation”, one able to completely change a way of doing things. The research we conducted for many years before proved that changing and replacing soap and water hand washing with the use of alcohol-based hand rubbing was definitely the way to transform hand hygiene promotion and to transform health care.

#3 Diversey: Every year you dedicate yourself to promoting hand hygiene specifically with the 5th of May campaign. In recent years the campaign has brought different themes, can you explain this year's theme and why the campaign is so important?

Professor Didier Pittet: This year's theme is extremely important for us, of course as the ones driving it, but it is very, very important for the whole World Health Organization. It is universal health coverage and "Health for All", something vitally important to the World Health Organization and in particular for the WHO Director General, Dr. Tedros Adhanom Ghebreyesus. I met with Dr. Tedros recently to prepare our 5th of May message. Usually, I give the 5th of May message myself, or together with WHO, but this year I'm giving it with Dr. Tedros which says a lot about the importance of universal health care. Universal health care in common words "Health For All", is directly linked to hand hygiene.

Why is it linked? If you want universal health coverage, if you want quality health coverage for all around the world, you cannot do it without appropriate hand hygiene behaviors. "Clean Care for All" is only obtained by cleaning your hands. “Clean Care for All" means "Health for all". This is why we call our theme "Clean Care For All, Its In Your Hands", because it is in the hands of all people that we want to mobilize whether it be ministries of health, health facility leaders, infection prevention and control leaders, health care workers, or even patients or patient advocacy groups.

The call for action for this year is that everyone should act for clean hands including patients. We tell patients it is your right to act for clean hands, it is your right to act for health for all, Clean Care for All. For me, this is critically important, as it is for the everyone at the WHO, and particularly Dr Tedros, the director general of WHO. This is why this year’s theme is so important to link to our campaign.

Also important is the global survey launched at the beginning of the year. Hospitals are invited to complete this survey right up until July 16th. They are asked to monitor their capabilities to achieve a powerful and successful infection control program by using two tools. The first is the Infection Prevention and Control (IPC) Assessment Framework (IPCAF), which was developed by the WHO and WHO Collaborating Centre. The second is a tool we have used for several years called the “WHO Hand Hygiene Self-Assessment Framework, a tool that monitors the capacity of the institution to promote hand hygiene. This survey can be found here.

The WHO Hand Hygiene Self-Assessment Framework was created in 2010, validated in 2011, and has been widely used since. In 2011 we did a worldwide survey looking at the capacity of hospitals around the world to promote hand hygiene. We repeated the survey in 2015 and are repeating it again this year so that we can compare the way institutions are actually improving their capacity to promote hand hygiene, and we are seeing improvements! By comparing the data from 2011 and 2015 we proved institutions all around the world could improve their capacity to promote hand hygiene and we hope that in 2019 we will demonstrate further progression. I am convinced this is the case, at least for many hospitals that I have visited all around the world.

#4 Diversey: And what will the WHO do with this information?

Professor Didier Pittet: The WHO writes an anonymous report, we do not cite which hospitals participate, but it still provides an average range of scoring. The idea is really to have a graphic of the situation so that we can continuously see how and when and how much we could continue to improve the situation according to countries or regions of the world.

Whilst the survey is anonymous, we can tell if the hospital is in Switzerland or in Ghana or in New York, or in Hong Kong. By knowing this we can see if the hospitals in the region are improving or not. It’s important because hospitals can realize where they sit on the scale if they are average or amongst the best. It's good for them to know that they can continue to make progress. Together with these tools, accompanied by others to help them to make progress, and that's exactly what we want.

#5 Diversey. Can you state why a health care facility should complete the survey and why they should input their data?

Professor Didier Pittet: Well, clearly because above all, these tools are useful for their own use. I personally use these tools in my institution every year despite the fact that we are among the best hospitals in the world for hand hygiene promotion. I can tell you by using the tool to monitor progress we realize that we can make continuous improvements. Maybe the most important reason for a hospital to monitor their capacity for a successful infection prevention and control program and their capacity to promote hand hygiene is for themselves.

At the end, when they have filled out the questionnaire, they will have a score. Whether it is 350 or 420, they can compare themselves to the results that have been published in other years. In Italy, in Australia, in Romania and many other countries, the data has been published before so people can compare their hospital to others, this is extremely useful. It is a benchmarking system. Benchmark yourself against the rest of the world, against your region, or against your country. Everything will be published officially in a report before the end of the year (2019).

#6 Diversey: As a part of the WHO Private Organizations for Patient Safety (POPS), an organization you helped to form, how do you think POPS is important?

Professor Didier Pittet: The idea formed because so many companies from around the world were asking me or asking WHO about health in different domains and for me, it is impossible to work with only one company, I have never done that and I never will. I will continue to work with ALL companies interested in promoting hand hygiene, promoting behavioral change, promoting the best products to clean your hands, promoting the best attitude, promoting the actions to mobilize a country, promoting the back-end research agenda etc.

We sit together with POPS companies at least twice a year to discuss an agenda. This can include the future 5th of May campaign, common projects that we are developing, and a research agenda that makes sense. We address problems like fake news and discuss creating humanitarian projects together.

At the time of the Ebola outbreak in 2014 in West Africa, all companies responded immediately within 2 weeks with extremely large amounts of alcohol-based hand rub that we could ship to Africa at the point of the Ebola outbreak where there was absolutely no alcohol-based hand rub available. We may continue to develop these kinds of common projects in order to improve patient safety and in order to actively save lives.

What is interesting in some companies is their distributors, some of those companies are more active in deep-seated research in the development of new products, some of the companies are working mostly on the distribution of products, some of the companies are better prepared at marketing and publicity, and last but not least, with the many companies that form POPS we can cover the entire world.

WHO can translate in only 6 different languages, the official WHO languages, English, French, Spanish, Russian, Arabic and Chinese. But, of course, we need more. We need Slovakian languages, we need African languages, we need Indonesian etc. Together with the POPS, we can translate tools. Last year we covered 192 of the 194 countries around the world. So this gives you a fantastic example of how all those companies working together with a common goal could succeed.

Diversey: Can you elaborate more on POPS role?

The role POPS plays is absolutely critical. POPS help provide graphics artists and digital marketing people. They actively share ideas, translate materials into many different languages, and last but not least, distribute the material all around the world.

One member of the POPS actually said during one of the POPs meetings that it’s very clear that none of us here around the table can cover the entire world—some of the companies are more active in Indonesia and some of the other companies are more active in Northern Europe, some others are more active in Latin America and we cover the world with this campaign. That's a very key element because these people working for companies, visiting hospitals and health care centres all over the world issue these facilities with the material we developed at WHO and distribute those messages.

In some hospitals, you have just one infection control nurse working part-time for infection control and she probably has no time to even look at the program materials this year, or even look at the campaign slogan. Even if she looked at it, she may have no time to print the 100 posters that she wants to hang on the hospital walls. So, by this, you can see clearly the importance of POPS.

It's clearly, a very, very unique movement that we have created and it is extremely successful. And, last but not least, companies sharing on social media. This interview is a good example. Today our campaign is mostly developed through social media and it works! Last year we probably reached more than 250 million people with this campaign and certainly, there is no single company who can do that. We can only succeed that way, together.

#7 Diversey: What would you like to say to anyone working in a healthcare facility today who may be reading this interview?

Professor Didier Pittet: Well, I wish first of all that this institution, and the person in this institution will have participated in the global survey. If not, they can still do it and they can still register their hospital into the WHO database. They can score themselves, and they can take actions in their institutions once they see the score.

Then, of course, I would encourage all to participate in the 5th of May campaign. When we say the “5th of May Campaign”, we are celebrating basically between the 1 or 2 of May up to the 10th or 15th of May all around the world. It depends on the country, though it’s true that on the 5th of May there are major activities. This year the 5th of May is on a Sunday. For example, in Geneva, we will celebrate the “5th of May” on the 2nd of May. On the 3rd of May, I will give a Webber teleclass all over the world. On the 4th of May, I will be giving a lecture in Geneva. On the 5th of May I will be on social media. On the 6th of May, I will also be on social media etc.

It’s clear that when we say the “5th of May”, we are saying let’s celebrate hand hygiene all together in the period around the 5th of May. But more importantly, we provide tools and activities that you can do all around the year and this is what is extremely important.

This year we also proposed to do solidarity chains, the first solidarity chain was made on World Health Day at the WHO building (5 April 2019). We also propose all hospitals continue to do solidarity chains all year long to celebrate universal health coverage, health for all, and this year's campaign, "Clean care for all, it's in your hands".

Diversey would like to thank Professor Pittet for taking the time to discuss these important topics with us, our customers and our readers. We urge all healthcare facilities to join the campaign, to join the survey and to join hands for the solidarity chain this May.